Super obese have a greater risk of death after bariatric surgery

According to a new study published in the October 2009 issue of Archives of Surgery, super obese patients and those with a higher chronic disease burden (e.g., congestive heart failure, complicated diabetes, and chronic obstructive pulmonary disease) are more likely to die within a year of having bariatric surgery.

Although bariatric surgery can assist obese individuals to lose enough weight to improve their quality of health and quality of life, previous studies have focused of the younger female population. Dr David Arterburn, Group Health Research Institute, Seattle, WA, and colleagues from several Veterans Affairs (VA) medical facilities (VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center), decided to investigate the patient factors associated with mortality among veterans who undergo bariatric surgery. This prospective study utilised data from the VA National Surgical Quality Improvement Program.

Patient groups

The researchers identified 856 veterans who underwent bariatric surgery in any of 12 VA bariatric centres from 2000 to 2006. The patients had an average body mass index (BMI) of 48.7 and an average age of 54 years. Seventy-three percent of the patient population were male, 83.9% were white, 7.0% had an ASA class equal to 4 and a mean diagnostic cost groups (DCG) score of 0.76. Patients who were classified as super obese (BMI of >50) represented 36% of all patients.

Outcomes

The researchers reported that 6.3% of patients died (n=54) during the follow-up period; 1.3% of the patients died 30 days after surgery, 2.1% died 90 days after surgery, and 3.4% had died after one year. The super obese patients, who accounted for 30 deaths, had 30-day, 90-day, and one-year death rates of 2.0%, 3.6%, and 5.2% (super obesity; hazard ratio [HR], 1.8; p=0.04). In addition, patients with a higher comorbidity cost score (a DCG score greater than or equal to 2 [HR, 3.4; p<0.001]) had mortality rates of 1.5%, 5.8%, and 10.1%, respectively.

Conclusions

The researchers concluded from their investigations that super obese veterans and those with a greater burden of chronic disease had a greater risk of death after bariatric surgery. “The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery,” the authors note. “These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities should be carefully weighed against potential benefits in older male patients and those with super obesity.”

According to the authors, there are several possible reasons for the increased risk following surgery including: bariatric surgical procedures are technically more difficult in these patients because of the amount of abdominal fat; an increased risk of wound complications and venous thrombo-embolism; and an increased likelihood of comorbidities.

The researchers also noted that the number of bariatric procedures performed in approved VA medical facilities tripled between 2000 and 2006. “Whether the volume of the VA bariatric surgery programme should be expanded in the coming years largely depends on the impact such operations have on long-term health outcomes.”

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